Mind the gap: Gaps in antidepressant treatment, treatment adjustments, and outcomes among patients in routine HIV care in a multisite U.S. Clinical cohort

Rushina Cholera, Brian W. Pence, Angela M. Bengtson, Heidi M. Crane, Katerina Christopoulos, Steven R. Cole, Rob Fredericksen, Bradley N. Gaynes, Amy Heine, W. Christopher Mathews, Matthew J. Mimiaga, Richard Moore, Sonia Napravnik, Conall O'Clerigh, Steven Safren, Michael J. Mugavero

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Depression affects 20-30% of HIV-infected patients and is associated with worse HIV outcomes. Although effective depression treatment is available, depression is largely untreated or undertreated in this population. Methods: We quantified gaps in antidepressant treatment, treatment adjustments, and outcomes among US patients in routine HIV care in the nationally distributed CNICS observational clinical cohort. This cohort combines detailed clinical data with regular, self-reported depressive severity assessments (Patient Health Questionnaire-9, PHQ-9). We considered whether participants with likely depression received antidepressants, whether participants on antidepressants with persistently high depressive symptoms received timely dose adjustments, and whether participants achieved depression remission. We considered a cross-sectional analysis (6,219 participants in care in 2011-2012) and a prospective analysis (2,936 participants newly initiating CNICS care when PHQ-9 screening was active). Results: The cross-sectional sample was 87% male, 53% Caucasian, 25% African American, and 18% Hispanic; the prospective sample was similar. In both samples, 39-44% had likely depression, with 44-60% of those receiving antidepressants. Of participants receiving anti-depressants, 20-26% experienced persistently high depressive symptoms; only a small minority of those received antidepressant dose adjustments. Overall, 35-40% of participants on antidepressants achieved full depression remission. Remission among participants with persistently high depressive symptoms was rare regardless of dose adjustments. Conclusions: In this large, diverse cohort of US patients engaged in routine HIV care, we observed large gaps in antidepressant treatment, timely dose adjustment to address persistently high depressive symptoms, and antidepressant treatment outcomes. These results highlight the importance of more effective pharmacologic depression treatment models for HIV-infected patients.

Original languageEnglish (US)
Article numbere0166435
JournalPLoS One
Volume12
Issue number1
DOIs
StatePublished - Jan 1 2017

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Social Adjustment
antidepressants
Antidepressive Agents
HIV
Depression
signs and symptoms (animals and humans)
remission
Therapeutics
dosage
questionnaires
Health
patient care
African Americans
cross-sectional studies
sampling
Screening
screening
Hispanic Americans
Patient Care

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Cholera, R., Pence, B. W., Bengtson, A. M., Crane, H. M., Christopoulos, K., Cole, S. R., ... Mugavero, M. J. (2017). Mind the gap: Gaps in antidepressant treatment, treatment adjustments, and outcomes among patients in routine HIV care in a multisite U.S. Clinical cohort. PLoS One, 12(1), [e0166435]. https://doi.org/10.1371/journal.pone.0166435

Mind the gap : Gaps in antidepressant treatment, treatment adjustments, and outcomes among patients in routine HIV care in a multisite U.S. Clinical cohort. / Cholera, Rushina; Pence, Brian W.; Bengtson, Angela M.; Crane, Heidi M.; Christopoulos, Katerina; Cole, Steven R.; Fredericksen, Rob; Gaynes, Bradley N.; Heine, Amy; Mathews, W. Christopher; Mimiaga, Matthew J.; Moore, Richard; Napravnik, Sonia; O'Clerigh, Conall; Safren, Steven; Mugavero, Michael J.

In: PLoS One, Vol. 12, No. 1, e0166435, 01.01.2017.

Research output: Contribution to journalArticle

Cholera, R, Pence, BW, Bengtson, AM, Crane, HM, Christopoulos, K, Cole, SR, Fredericksen, R, Gaynes, BN, Heine, A, Mathews, WC, Mimiaga, MJ, Moore, R, Napravnik, S, O'Clerigh, C, Safren, S & Mugavero, MJ 2017, 'Mind the gap: Gaps in antidepressant treatment, treatment adjustments, and outcomes among patients in routine HIV care in a multisite U.S. Clinical cohort', PLoS One, vol. 12, no. 1, e0166435. https://doi.org/10.1371/journal.pone.0166435
Cholera, Rushina ; Pence, Brian W. ; Bengtson, Angela M. ; Crane, Heidi M. ; Christopoulos, Katerina ; Cole, Steven R. ; Fredericksen, Rob ; Gaynes, Bradley N. ; Heine, Amy ; Mathews, W. Christopher ; Mimiaga, Matthew J. ; Moore, Richard ; Napravnik, Sonia ; O'Clerigh, Conall ; Safren, Steven ; Mugavero, Michael J. / Mind the gap : Gaps in antidepressant treatment, treatment adjustments, and outcomes among patients in routine HIV care in a multisite U.S. Clinical cohort. In: PLoS One. 2017 ; Vol. 12, No. 1.
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abstract = "Background: Depression affects 20-30{\%} of HIV-infected patients and is associated with worse HIV outcomes. Although effective depression treatment is available, depression is largely untreated or undertreated in this population. Methods: We quantified gaps in antidepressant treatment, treatment adjustments, and outcomes among US patients in routine HIV care in the nationally distributed CNICS observational clinical cohort. This cohort combines detailed clinical data with regular, self-reported depressive severity assessments (Patient Health Questionnaire-9, PHQ-9). We considered whether participants with likely depression received antidepressants, whether participants on antidepressants with persistently high depressive symptoms received timely dose adjustments, and whether participants achieved depression remission. We considered a cross-sectional analysis (6,219 participants in care in 2011-2012) and a prospective analysis (2,936 participants newly initiating CNICS care when PHQ-9 screening was active). Results: The cross-sectional sample was 87{\%} male, 53{\%} Caucasian, 25{\%} African American, and 18{\%} Hispanic; the prospective sample was similar. In both samples, 39-44{\%} had likely depression, with 44-60{\%} of those receiving antidepressants. Of participants receiving anti-depressants, 20-26{\%} experienced persistently high depressive symptoms; only a small minority of those received antidepressant dose adjustments. Overall, 35-40{\%} of participants on antidepressants achieved full depression remission. Remission among participants with persistently high depressive symptoms was rare regardless of dose adjustments. Conclusions: In this large, diverse cohort of US patients engaged in routine HIV care, we observed large gaps in antidepressant treatment, timely dose adjustment to address persistently high depressive symptoms, and antidepressant treatment outcomes. These results highlight the importance of more effective pharmacologic depression treatment models for HIV-infected patients.",
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AU - Pence, Brian W.

AU - Bengtson, Angela M.

AU - Crane, Heidi M.

AU - Christopoulos, Katerina

AU - Cole, Steven R.

AU - Fredericksen, Rob

AU - Gaynes, Bradley N.

AU - Heine, Amy

AU - Mathews, W. Christopher

AU - Mimiaga, Matthew J.

AU - Moore, Richard

AU - Napravnik, Sonia

AU - O'Clerigh, Conall

AU - Safren, Steven

AU - Mugavero, Michael J.

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N2 - Background: Depression affects 20-30% of HIV-infected patients and is associated with worse HIV outcomes. Although effective depression treatment is available, depression is largely untreated or undertreated in this population. Methods: We quantified gaps in antidepressant treatment, treatment adjustments, and outcomes among US patients in routine HIV care in the nationally distributed CNICS observational clinical cohort. This cohort combines detailed clinical data with regular, self-reported depressive severity assessments (Patient Health Questionnaire-9, PHQ-9). We considered whether participants with likely depression received antidepressants, whether participants on antidepressants with persistently high depressive symptoms received timely dose adjustments, and whether participants achieved depression remission. We considered a cross-sectional analysis (6,219 participants in care in 2011-2012) and a prospective analysis (2,936 participants newly initiating CNICS care when PHQ-9 screening was active). Results: The cross-sectional sample was 87% male, 53% Caucasian, 25% African American, and 18% Hispanic; the prospective sample was similar. In both samples, 39-44% had likely depression, with 44-60% of those receiving antidepressants. Of participants receiving anti-depressants, 20-26% experienced persistently high depressive symptoms; only a small minority of those received antidepressant dose adjustments. Overall, 35-40% of participants on antidepressants achieved full depression remission. Remission among participants with persistently high depressive symptoms was rare regardless of dose adjustments. Conclusions: In this large, diverse cohort of US patients engaged in routine HIV care, we observed large gaps in antidepressant treatment, timely dose adjustment to address persistently high depressive symptoms, and antidepressant treatment outcomes. These results highlight the importance of more effective pharmacologic depression treatment models for HIV-infected patients.

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